Researchers evaluated 17,239 patients (77% older than 60; 31% tobacco users) with COPD exacerbations who were admitted to ICUs at 473 U.S. hospitals. Nearly one third of patients received noninvasive ventilation; 15% were intubated. Almost all patients received antibiotics and bronchodilators. Methylprednisolone doses were categorized as either high (>240 mg) or low (≤240 mg), based on total methylprednisolone administered on hospital day 1 or 2; 11,083 patients (64%) received high doses.
Patients in the two groups were matched by propensity scoring. After adjusting for unbalanced covariates, the groups had similar in-hospital mortality. Compared with high-dose treatment, low-dose treatment was associated with shorter ICU and hospital lengths of stay, lower hospital costs, and shorter duration of mechanical ventilation. Low-dose patients were less likely to require insulin therapy or develop fungal infections.
This study indicated that doses of methylprednisolone <240 mg/day is superior to doses >240 mg/day. Most experts suggests that doses of methylprednisolone 40-80 mg IV bid is sufficient even for severe COPD exacerbations admitted to the ICU.
More studies are needed to determine the optimal dosing for moderate-severe COPD exacerbations (60-160 mg per day methylprednisolone)
Kiser TH et al. Outcomes associated with corticosteroid dosage in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014 May 1; 189:1052
Abroug F and Krishnan JA.What is the right dose of systemic corticosteroids for intensive care unit patients with chronic obstructive pulmonary disease exacerbations? A question in search of a definitive answer. Am J Respir Crit Care Med 2014 May 1; 189:1014.